Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine.

OBJECTIVES: To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome. METHODS: Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model. RESULTS: Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26). DISCUSSION: The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.

ON THE ISSUES OF PROVISION OF DRUG AID AT THE PRIMARY LEVEL OF MEDICAL ASSISTANCE.

OBJECTIVE: The aim: Establish the types of narcological care to be provided at the primary level, develop a functional and organizational model of anti-narcotic activity of general practitioners/ family doctors and an algorithm for its integration at the primary level. PATIENTS AND METHODS: Materials and methods: Determination of types of anti-narcotic activity of GPs/family doctors was carried out expertly. The experts were 36 health care providers, doctors and alcohol abusers. The experts evaluated the proposed activities on a 10 point scale: full support - 10 points, and total ineligibility - 0 points. Expert opinion confidentiality saved. The bibliosemantic method and the method of structural-logical analysis were used in the work. The statistical method was used for statistical processing of the obtained results. RESULTS: Results: The list of types of medical care is grounded and the functional-organizational model of anti-narcotic activity of general practitioners-family doctors is developed, as well as the algorithm of integration into the primary level of complex anti-narcotic medical care to the population and the motivational mechanisms for the employees of primary level are offered to encourage them to the anti-narcotics activities. CONCLUSION: Conclusions: implementation of the proposed innovations will increase the availability and effectiveness of anti-narcotic activities at the local level.

[Characteristic of morbidity indices and prevalence of diseases among the population of transcarpathian region].

OBJECTIVE: Introduction: The state of people's health takes a special place in the system of values of the civilized countries. The health of the population of the country reflects it's socio-economic, environmental, demographic, and sanitary-and-hygienic welfare and is one of the social indicators of society progress, an important factor that impacts the quality and efficiency of labor resources. The aim: Study and analyze the morbidity and prevalence of disease among the population of Transcarpathian region in terms of administrative areas. PATIENTS AND METHODS: Materials and methods: Statistical and bibliosemantic methods were applied in the course of study. The data of branch statistical reporting of Transcarpathian region for the period 2015-2017 were used as materials for research. RESULTS: Review: The trend towards decreasing the prevalence of diseases among adult population and morbidity indices and the prevalence of diseases among infants was registered in the region. The increase of morbidity index of adult population was registered. The indices of morbidity and the prevalence of diseases among population show proved differences in terms of administrative areas of the region. CONCLUSION: Conclusions: The indices of morbidity and the prevalence of diseases among population work as an important factor when planning a reform in the system of providing medical aid to the population and the level of its financing.